San Francisco General Hospital claims to have no medications. Nurses speak differently

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Nurses at the city’s main publicly funded hospital say they are worried about policies that in some cases actually force them to return meth and fentanyl to patients trapped in the revolving door of addiction and mental illness.

Hospital staff are required to return the patient’s personal property upon discharge, even if it may contain the illegal drugs that brought the patient to the hospital. And ambiguous procedures for treating patients arriving at the hospital with medications are a concern for medical professionals who are increasingly bearing the brunt of the city’s mental health crises.

Zuckerberg General Hospital in San Francisco said it is asking patients to report if they have unprescribed medications, but according to the statement, it does not have the authority to search them “without lawful or statutory grounds.” Patients are “offered the opportunity to dispose of any substances or consumables for substance use with the hospital,” the hospital said.

“Zuckerberg San Francisco General Hospital (ZSFG) is a drug-free campus. We do not condone or tolerate the use of illegal drugs on our campus by anyone,” the statement said.

But some nurses say they often feel stuck between adhering to the hospital’s “substance-free zone” policy and rules restricting them from confiscating a patient’s personal property.

In addition, some have questioned whether the hospital is placing an undue burden on frontline medical staff as they care for patients who use street drugs, who are becoming more dangerous.

“We have these crazy lines in the sand. You’re not allowed to smoke a cigarette on our campus, but can’t I take your fentanyl away? said Heather Bollinger, a longtime nurse at SF General. “If the institution really wants to support this harm reduction model, and if it’s a priority, then how do we take the nurse out of the equation?”

Many nurses were afraid to talk about it publicly for fear of retribution.

“You’re in a really serious, unsafe situation and we’re not getting support,” San Francisco General Surgery Nurse Megan Green told The Standard. “So often people just quit.”

Some fear that if their patients experience an overdose shortly after being discharged from the hospital, they could be sued for contributing to death. On the other hand, they say, confiscating medicines from a patient can sow distrust in the medical system.

Bollinger told The Standard that she believes “there is no right or wrong answer to the problem” but expressed frustration at how policies coming from the hospital’s top management can have a debilitating effect on frontline staff.

“Treating the patient as an alleged perpetrator is not conducive to the therapeutic environment. I am someone who believes in the harm reduction model,” Bollinger said. “But every time a bad outcome happens, I watch my colleagues get punished.”

There have been 84 fatal overdose deaths at San Francisco General Hospital since January 1, 2020, according to data from San Francisco’s Chief Medical Examiner, although it is unclear how many, if not all, of these patients overdosed prior to arrival. in hospital. hospital.

SF General Hospital said in a statement that indoor overdoses are “extremely rare.”

But the description of the general hospital as a drug-free zone is inconsistent with the accounts of the nurses, who said they did not have protocols in place to enforce such a policy.

Nurses who spoke to The Standard said they sometimes catch their clients using hard drugs in the hospital, and that they sometimes overdosed while the staff is serving other clients.

An incident last week in which a man used fentanyl in his hospital room led some healthcare professionals to form a task force to look at more effective drug control procedures in the hospital.

“It’s stupid and typical to just say, ‘Well, we tell people not to do this,'” Bollinger said. “When they do [use drugs]what happens then?”

Jeffrey Grier, executive director of the city’s Behavioral Health Commission, said handling a patient’s illegal drugs should not be the responsibility of medical personnel. Grier suggested that a third party, such as the California Poison Control System, might be involved in the drugs.

“Let’s say they give them their drugs back and the person overdoses and dies,” Grier said. “When a family comes and sues the nurse for giving them medication. Who is responsible? Who pays legal costs?

Boone Callaway, a lawyer who specializes in medical malpractice litigation, said the idea that nurses could play any role in dealing with illegal drugs didn’t make sense to him.

“It looks like a problem that would be so easy to avoid,” Callaway said. “I don’t know if this law has ever been clarified. […] But potentially there is a possibility of liability, why would they even come close to it?”

Other experts are not sure that the problem can be solved quickly.

Keith Humphreys, a Stanford professor who advised President Obama on drug control policy, said there was probably no solution to the problem unless the city’s inability to control the supply of drugs and provide treatment for drug addicts was first addressed.

“The solution to this problem lies upstream,” Humphreys said. “It’s one of those things that happens when you have a drug crisis that’s out of control. This puts many people in a stalemate.”

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